経裂孔的腹腔鏡下切除を行った多発横隔膜上食道憩室の1例

症例は53歳の男性で，3年前からのつかえ感と食事中の嘔吐を主訴に当科へ紹介された．食道造影検査および上部消化管内視鏡検査で胸部下部食道右側に長径6 cm大の憩室，やや肛門側の食道左側に長径3 cm大の憩室を認めた．食道内圧検査では鼻腔より23 cmの食道から一次蠕動波の消失，同期性異常収縮波，下部食道括約筋（lower esophageal sphincter；以下，LESと略記）圧上昇，LESの嚥下性弛緩の消失を認めた．食道運動障害を背景とした多発横隔膜上食道憩室と診断し，症状が増悪してきたため外科的治療の方針とした．腹腔鏡下に経裂孔アプローチで両側の憩室を切除しHeller粘膜外筋層切開術...

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Published in日本消化器外科学会雑誌 Vol. 51; no. 9; pp. 543 - 550
Main Authors 安井, 應紀, 加藤, 裕治郎, 高橋, 貞二, 佐々木, 智彦, 本山, 悟
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 01.09.2018
Subjects
横隔膜上食道憩室
経裂孔的腹腔鏡下切除
食道運動障害
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2018.0015

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Abstract 症例は53歳の男性で，3年前からのつかえ感と食事中の嘔吐を主訴に当科へ紹介された．食道造影検査および上部消化管内視鏡検査で胸部下部食道右側に長径6 cm大の憩室，やや肛門側の食道左側に長径3 cm大の憩室を認めた．食道内圧検査では鼻腔より23 cmの食道から一次蠕動波の消失，同期性異常収縮波，下部食道括約筋（lower esophageal sphincter；以下，LESと略記）圧上昇，LESの嚥下性弛緩の消失を認めた．食道運動障害を背景とした多発横隔膜上食道憩室と診断し，症状が増悪してきたため外科的治療の方針とした．腹腔鏡下に経裂孔アプローチで両側の憩室を切除しHeller粘膜外筋層切開術とDor噴門形成術を行った．両側に同時性に存在する横隔膜上食道憩室の報告はまれであり，経裂孔的腹腔鏡下操作による外科的治療を行い良好な経過をたどった1例を経験した．
AbstractList 症例は53歳の男性で，3年前からのつかえ感と食事中の嘔吐を主訴に当科へ紹介された．食道造影検査および上部消化管内視鏡検査で胸部下部食道右側に長径6 cm大の憩室，やや肛門側の食道左側に長径3 cm大の憩室を認めた．食道内圧検査では鼻腔より23 cmの食道から一次蠕動波の消失，同期性異常収縮波，下部食道括約筋（lower esophageal sphincter；以下，LESと略記）圧上昇，LESの嚥下性弛緩の消失を認めた．食道運動障害を背景とした多発横隔膜上食道憩室と診断し，症状が増悪してきたため外科的治療の方針とした．腹腔鏡下に経裂孔アプローチで両側の憩室を切除しHeller粘膜外筋層切開術とDor噴門形成術を行った．両側に同時性に存在する横隔膜上食道憩室の報告はまれであり，経裂孔的腹腔鏡下操作による外科的治療を行い良好な経過をたどった1例を経験した．
Author 佐々木, 智彦
本山, 悟
安井, 應紀
加藤, 裕治郎
高橋, 貞二
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References 10) Zaninotto G, Portale G, Costantini M, Merigliano S, Guirroli E, Rizzetto G, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008 Sep;12(9):1485–1490.
12) Bognar G, Faller J, Ondrejka P. Unilateral double epiphrenic diverticula of the esophagus. Eur J Cardiothorac Surg. 2009 Apr;35(4):724.
15) Rosati R, Fumagalli U, Bona S, Zago M, Celotti S, Bisagni P, et al. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A. 2001 Dec;11(6):371–375.
4) 井手 博子，押淵 英晃，杉山 明徳．食道憩室症の病態と治療．カレントテラピー．1985;3:669–675.
17) Hirano Y, Takeuchi H, Oyama T, Saikawa Y, Niihara M, Sako H, et al. Minimally invasive surgery for esophageal epiphrenic diverticulum: the results of 133 patients in 25 published series and our experience. Surg Today. 2013 Jan;43(1):1–7.
9) Varghese TK Jr., Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula. A 30-year experience. Ann Thorac Surg. 2007 Dec;84(6):1801–1809.
14) Viard H, Favre JP, Cayot M, Lequin P, Merland G, Sow M. Epiphrenic diverticula of the esophagus. Apropos of 16 surgically-treated cases. Sem Hop. 1983 Feb;59(7):477–481.
11) 八坂 朗，嶺 博之，雷 哲明，東儀 公哲，河野 仁志，金森 弘明，ほか．本邦における良性食道疾患に併存した食道癌．日本消化器外科学会雑誌．1984;17(4):681–689.
8) Watson TJ, Jones CE, Litle VR. Benign diseases of the esophagus. Curr Probl Surg. 2009 Mar;46(3):195–259.
21) Rossetti G, Fei L, del Genito G, Maffettone V, Brusciano L, Tolone S, et al. Epiphrenic diverticula mini-invasive surgery: a challenge for expert surgions-personal experience and review of the literature. Scand J Surg. 2013;102(2):129–135.
16) Palanivelu C, Rangrajan M, John S, Parthasarathi R, Senthilkumar R. Laparoscopic transhiatal approach for benign supra-diaphragmatic lesions of the esophagus: a replacement for thoracoscopy? Dis Esophagus. 2008;21(2):176–180.
5) Postlethwait RW. Diverticula of the esophagus. Surgery of the esophagus, 2nd edition. Norwalk: Appleton-Century-Crofts; 1986. p. 129–159.
3) 日本食道学会編．食道アカラシア取扱い規約．第4版．東京：金原出版；2012.
7) Nehra D, Lord RV, Demeester TR, Theisen J, Peters JH, Crookes PF, et al. Physiologic basis for the Treatment of Epiphrenic diverticulum. Ann Surg. 2002 Mar;235(3):346–354.
23) Motoyama S, Maruyama K, Okuyama M, Sasaki K, Sato Y, Ogawa J. Laparoscopic long esophagomyotomy with Dor’s fundoplication using a transhiatal approach for an epiphrenic esophageal diverticulum. Surg Today. 2006;36(8):758–760.
13) Taniguchi Y, Takahashi T, Nakajima K, Higashi S, Tanaka K, Miyazaki Y, et al. Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report. Surg Case Rep. 2017 Dec;3(1):63.
2) Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut. 2001 Jul;49(1):145–151.
20) Rosati R, Fumagalli U, Elmore U, de Pacale S, Massaron S, Peracchia A. Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg. 2011 Jan;201(1):132–135.
1) 中村 努．食道憩室．臨床消化器内科．2000;15:749–755.
19) Chan DSY, Foliaki A, Lewis WG, Clark GWB, Blackshaw GRJC. Systematic review and meta-analysis of surgical treatment of non-Zenker’s oesophageal diverticula. J Gastrointest Surg. 2017 Jun;21(6):1067–1075.
6) 安部 俊弘，丹黒 章，岡 正朗．食道良性疾患の外科治療6，食道憩室．日本外科学会雑誌．2003;104:601–606.
18) Kinoshita Y, Udagawa H, Tsutsumi K, Ueno M, Mine S, Ehara K, et al. Modified Dor fundoplication technique following diverticulectomy and myotomy for epiphrenic diverticulum combined with esophageal motility disorders: prevention of esophageal leak at the diverticulectomy staple line. Esophagus. 2008 Mar;5(1):57–60.
22) Macke RA, Luketich JD, Pennathur A, Bianco V, Awais O, Gooding WE, et al. Thoracic esophageal diverticula: a 15-year experience of minimally invasive surgical management. Ann Thorac Surg. 2015 Nov;100(5):1795–1802.
References_xml – reference: 4) 井手 博子，押淵 英晃，杉山 明徳．食道憩室症の病態と治療．カレントテラピー．1985;3:669–675.
– reference: 23) Motoyama S, Maruyama K, Okuyama M, Sasaki K, Sato Y, Ogawa J. Laparoscopic long esophagomyotomy with Dor’s fundoplication using a transhiatal approach for an epiphrenic esophageal diverticulum. Surg Today. 2006;36(8):758–760.
– reference: 7) Nehra D, Lord RV, Demeester TR, Theisen J, Peters JH, Crookes PF, et al. Physiologic basis for the Treatment of Epiphrenic diverticulum. Ann Surg. 2002 Mar;235(3):346–354.
– reference: 13) Taniguchi Y, Takahashi T, Nakajima K, Higashi S, Tanaka K, Miyazaki Y, et al. Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report. Surg Case Rep. 2017 Dec;3(1):63.
– reference: 15) Rosati R, Fumagalli U, Bona S, Zago M, Celotti S, Bisagni P, et al. Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A. 2001 Dec;11(6):371–375.
– reference: 3) 日本食道学会編．食道アカラシア取扱い規約．第4版．東京：金原出版；2012.
– reference: 8) Watson TJ, Jones CE, Litle VR. Benign diseases of the esophagus. Curr Probl Surg. 2009 Mar;46(3):195–259.
– reference: 19) Chan DSY, Foliaki A, Lewis WG, Clark GWB, Blackshaw GRJC. Systematic review and meta-analysis of surgical treatment of non-Zenker’s oesophageal diverticula. J Gastrointest Surg. 2017 Jun;21(6):1067–1075.
– reference: 9) Varghese TK Jr., Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula. A 30-year experience. Ann Thorac Surg. 2007 Dec;84(6):1801–1809.
– reference: 17) Hirano Y, Takeuchi H, Oyama T, Saikawa Y, Niihara M, Sako H, et al. Minimally invasive surgery for esophageal epiphrenic diverticulum: the results of 133 patients in 25 published series and our experience. Surg Today. 2013 Jan;43(1):1–7.
– reference: 22) Macke RA, Luketich JD, Pennathur A, Bianco V, Awais O, Gooding WE, et al. Thoracic esophageal diverticula: a 15-year experience of minimally invasive surgical management. Ann Thorac Surg. 2015 Nov;100(5):1795–1802.
– reference: 6) 安部 俊弘，丹黒 章，岡 正朗．食道良性疾患の外科治療6，食道憩室．日本外科学会雑誌．2003;104:601–606.
– reference: 2) Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut. 2001 Jul;49(1):145–151.
– reference: 1) 中村 努．食道憩室．臨床消化器内科．2000;15:749–755.
– reference: 10) Zaninotto G, Portale G, Costantini M, Merigliano S, Guirroli E, Rizzetto G, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008 Sep;12(9):1485–1490.
– reference: 16) Palanivelu C, Rangrajan M, John S, Parthasarathi R, Senthilkumar R. Laparoscopic transhiatal approach for benign supra-diaphragmatic lesions of the esophagus: a replacement for thoracoscopy? Dis Esophagus. 2008;21(2):176–180.
– reference: 12) Bognar G, Faller J, Ondrejka P. Unilateral double epiphrenic diverticula of the esophagus. Eur J Cardiothorac Surg. 2009 Apr;35(4):724.
– reference: 21) Rossetti G, Fei L, del Genito G, Maffettone V, Brusciano L, Tolone S, et al. Epiphrenic diverticula mini-invasive surgery: a challenge for expert surgions-personal experience and review of the literature. Scand J Surg. 2013;102(2):129–135.
– reference: 11) 八坂 朗，嶺 博之，雷 哲明，東儀 公哲，河野 仁志，金森 弘明，ほか．本邦における良性食道疾患に併存した食道癌．日本消化器外科学会雑誌．1984;17(4):681–689.
– reference: 18) Kinoshita Y, Udagawa H, Tsutsumi K, Ueno M, Mine S, Ehara K, et al. Modified Dor fundoplication technique following diverticulectomy and myotomy for epiphrenic diverticulum combined with esophageal motility disorders: prevention of esophageal leak at the diverticulectomy staple line. Esophagus. 2008 Mar;5(1):57–60.
– reference: 20) Rosati R, Fumagalli U, Elmore U, de Pacale S, Massaron S, Peracchia A. Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg. 2011 Jan;201(1):132–135.
– reference: 14) Viard H, Favre JP, Cayot M, Lequin P, Merland G, Sow M. Epiphrenic diverticula of the esophagus. Apropos of 16 surgically-treated cases. Sem Hop. 1983 Feb;59(7):477–481.
– reference: 5) Postlethwait RW. Diverticula of the esophagus. Surgery of the esophagus, 2nd edition. Norwalk: Appleton-Century-Crofts; 1986. p. 129–159.
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Snippet 症例は53歳の男性で，3年前からのつかえ感と食事中の嘔吐を主訴に当科へ紹介された．食道造影検査および上部消化管内視鏡検査で胸部下部食道右側に長径6 cm大の憩室，やや肛門側の食道左側に長径3 cm大の憩室を認めた．食道内圧検査では鼻腔より23...
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SourceType Publisher
StartPage 543
SubjectTerms 横隔膜上食道憩室
経裂孔的腹腔鏡下切除
食道運動障害
Title 経裂孔的腹腔鏡下切除を行った多発横隔膜上食道憩室の1例
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